Managing Patients With Short-Term Mechanical Circulatory Support

Balthazar, Tim; Vandenbriele, Christophe; Verbrugge, Frederik H.; Uil, Corstiaan A. den; Engström, Annemarie E.; Janssens, Stefan; Rex, Steffen; Meyns, Bart; Mieghem, Nicolas Van; Price, Susanna; Adriaenssens, Tom

doi:10.1016/j.jacc.2020.12.054

Cited by 77 publications

(92 citation statements)

References 41 publications

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“…Haemolysis is another significant complication and its incidence is variably reported between 8% to 63% [69,76]. Such variation may reflect the local methods of management of Impella and usually is addressed by repositioning the device or managing the preload [77]. The incidence of other complications includes vascular (10%), bleeding requiring transfusion (17.5%) or requiring surgical intervention (2.6%) [74].…”

Section: Impellamentioning

confidence: 99%

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Al‐Atta¹,

Zaidan²,

Abdalwahab³

et al. 2022

Rev. Cardiovasc. Med.

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Patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) have poor prognosis. Over the last two decades, there has been some improvement in mortality rates associated with CS. Initial measures to stabilise patients should follow a shock protocol, including therapies such as volume expansion, inotropes/vasopressors, and early coronary revascularisation. The use of mechanical circulatory support (MCS) devices demonstrated better haemodynamic and metabolic profiles for patients with CS. However, these benefits have not been consistently translated into significant reductions in cardiovascular adverse events. This review aims to discuss emerging concepts related to CS including an update on its classification and pathophysiology. The focus is on recent evidence regarding the use of MCS and the timing of initiating in patients with CS.

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Section: Impellamentioning

confidence: 99%

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Al‐Atta¹,

Zaidan²,

Abdalwahab³

et al. 2022

Rev. Cardiovasc. Med.

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“…The catheter-based, continuous microaxial ow pumps Impella® 2.5, CP and CP Smart Assist can be implanted fully percutaneously, generally through the femoral artery. 2,5 The Impella® 2.5 and CP have an introducer sheath diameter of 12 and 14 French, respectively. 2,5 As part of our clinical routine, we obtained a contrast angiogram in an ipsilateral projection to assess puncture height and anatomical suitability of the iliac and femoral arteries prior to Impella® insertion.…”

Section: Impella® Devicementioning

confidence: 99%

“…2,5 The Impella® 2.5 and CP have an introducer sheath diameter of 12 and 14 French, respectively. 2,5 As part of our clinical routine, we obtained a contrast angiogram in an ipsilateral projection to assess puncture height and anatomical suitability of the iliac and femoral arteries prior to Impella® insertion. Ultrasound guidance was used, whenever possible.…”

Section: Impella® Devicementioning

confidence: 99%

“…All patients were anticoagulated with unfractionated heparin (UFH) to achieve an activated clotting time (ACT) >250s during PCI. Finally, the Impella® devices were inserted over a stiff 0.018-inch guide wire 2,5,9 , advanced under uoroscopy and positioned in a retrograde fashion across the aortic valve.…”

Section: Impella® Devicementioning

confidence: 99%

“…In this context, the catheter-based, continuous axial ow pumps Impella® 2.5 and CP have become the preferred pLVADs for patients with profound cardiogenic shock (CS) or requiring high-risk percutaneous coronary interventions (PCI). 2 Although, there is mounting data about strategies and devices for vascular closure in patients undergoing TAVR and EVAR, studies focusing on optimal non-surgical access closure in patients managed with the pLAVD Impella® remain scarce. In this context, one needs to take into account that Impella® removal on the intensive care unit (ICU) is particularly challenging and is prone to bleeding and vascular complications.…”

Section: Introductionmentioning

confidence: 99%

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Manual Compression Versus MANTA Device for Access Management After Impella Removal on the ICU

Cuculi

Burkart

Cioffi

et al. 2022

Preprint

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Objective: To compare the safety and efficacy of manual compression versus use of the MANTA® closure device for access management after Impella® removal on the intensive care unit (ICU).Background: The number of patients treated with percutaneous left ventricular assist devices (pLVAD), namely Impella® and ECMO, for complex cardiac procedures or shock, is growing. However, removal of pLVAD and large bore arteriotomy closure among such patients on the ICU remains challenging, since it is associated with a high risk for bleeding and vascular complications. Methods: Patients included in a prospective registry between 2017 and 2020 were analyzed. Bleeding and vascular access site complications were assessed and adjudicated according to VARC-2 criteria. Results: We analyzed a cohort of 87 consecutive patients, who underwent access closure after Impella® removal on ICU by using either the MANTA® device or manual compression. The cohort´s mean age was 66.1±10.7 years and 76 patients (87%) were recovering from CS. Mean support time was 40 hours (Interquartile range 24–69 hours). MANTA® was used in 31 patients (35.6%) and manual compression was applied in 56 patients (64.4%). Overall access related bleedings were significantly lower in the MANTA® group (6.5% versus 39.3%(odds ratio (OR) 0.10, 95% CI 0.01–0.50; p=0.001), and there was no significant difference in vascular complications between the two groups(p=0.55).Conclusions: Our data suggests that the application of the MANTA® device directly on the ICU is safe. In addition, it seems to reduce access related bleeding without increasing the risk of vascular complications.

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Pressure–strain loops unveil haemodynamics behind mechanical circulatory support systems

et al. 2023

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Aims Mechanical circulatory support (MCS) systems are increasingly employed in cardiogenic shock and advanced heart failure. A thorough understanding of the complex interactions occurring among heart, vasculature, and device is essential to optimize patient's management. The aim of this study is to explore non-invasive haemodynamic profiling of patients undergoing MCS based on pressure-strain (PS) analysis. Methods Clinical and echocardiographic data from consecutive patients undergoing different MCS systems positioning/implantation admitted to the third level cardiological intensive care unit of Siena Hospital from August 2021 to November 2021 were retrospectively reviewed. Patients without a useful echocardiographic exam or without arterial blood pressure recording at the time of echocardiography were excluded. Myocardial work analysis was performed in the included patients. ResultsWe reviewed 18 patients, of which nine were excluded. Included patients were three patients with intra-aortic balloon pump (IABP), two patients with durable left ventricular assist device (dLVAD), two patients with Impella®, one patient with extracorporeal membrane oxygenation (ECMO), and one patient with ECMO and IABP. Myocardial work analysis was feasible in each included patient. The use of IABP shifted the PS curve rightward and downward. Global work index (GWI) and global wasted work (GWW) decreased after IABP positioning, whereas global work efficiency (GWE) increased. The use of continuous-flow pumps, whether temporaneous (Impella®) or long term (dLVAD), induced a change in the PS loop morphology, with a shift towards a triangular shape. ECMO positioning alone resulted in a narrowing of the PS loop, with a decrease in GWI and GWE and an increase in GWW and mean arterial pressure. The combined used of IABP with ECMO widened the PS loop and improved GWI and GWE. Conclusions PS loops analysis in patients undergoing MCS seems to be feasible and may unveil MCS-induced haemodynamic variations. Myocardial work could be used to monitor ventricular-arterial-device coupling and guide tailored MCS management.

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Managing Patients With Short-Term Mechanical Circulatory Support

Cited by 77 publications

References 41 publications

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Manual Compression Versus MANTA Device for Access Management After Impella Removal on the ICU

Pressure–strain loops unveil haemodynamics behind mechanical circulatory support systems

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